Health Guide February 28, 2008
"I was watching some doctors on TV recently where a couple of overweight people with diabetes had three months to see whether they could reduce their weight through good nutrition and exercise," Gita in Australia emailed me this week. "These people achieved their goals and in describing the results, the doctors made the comment that, 'They didn't have diabetes any more.'"
Gita had thought that there is no cure for diabetes. So she searched the Internet and found other doctors who claim that they can reverse it.
Since Gita was still appropriately skeptical, she wrote me. I replied:
If a doctor thoroughly examined me today, he would find absolutely no evidence that I have diabetes (normal A1C, normal weight, normal cholesterol, normal blood pressure, no complications, no diabetes drugs). While it doesn't look like I have diabetes, I act like I do, so it won't return. I absolutely must adhere to the best principles of diabetes management to minimize the chances of recurrence.
There is no cure.
The most that I will claim for myself and for anyone who has his or her diabetes absolutely under control is that it is in remission. The word "reversing" is not precise enough for me.
If I had type 1 diabetes, all my efforts would not have put my diabetes into remission. That's because, based on current understanding, type 1s have lost all their beta cells in their pancreas and nothing can replace them short of a transplant, which would require them to take dangerous immunosuppressive drugs for the rest of their lives.
But I have type 2 diabetes, which is by far more common than type 1. There are two problems with type 2, which is why I call it a "two-hit disease."
Generally, the first problem that develops is insulin resistance in the cells of our bodies. So the pancreas must secrete more and more insulin in an attempt to get the insulin to transport glucose into the cells where we need it. Then, even before diabetes develops, these people -- who we say have pre-diabetes or the metabolic syndrome -- start to burn out their beta cells. They lose some of the beta cells in their pancreas, although not all of them (or essentially all of them) as type 1s do.
It is the insulin resistance that is reversible.
But we have absolutely no evidence in living people that any of the things that I did to put my diabetes into remission or those doctors did with the overweight people on the TV show that you saw will help to regenerate those dead beta cells. So people like me have to be extremely careful in our weight management and exercise lifestyle since we are essentially running on a gas tank that is nearly running out.
That said, there is some test tube evidence that we might be able to regenerate beta cells now or in the near future. This beta cell neogenesis might possibly be a huge side effect of taking the drug Byetta (and possibly some other drugs including insulin and Symlin), which I took for two years. It also looks like it might be occurring when tested in animals, but humans are a bit different from them.
This problem is the Heisenberg principle -- that you can't measure something without changing it. Most likely, the only way that we have to measure beta cell neogenesis is probably through an autopsy. For some personal reason, no one has volunteered.